1. Sport Injuries of the Knee

2. Objectives Revise anatomy Common injuries: Basic management Menisci
ACL, PCL
Collaterals
Basic management

3. Anatomy Compound joint Femoral condyles and Tibial articular surfaces
Patello-femoral joint
Menisci:
Medial / Lateral
Ligaments:
ACL, PCL
MCL, LCL

4. Anatomy (Menisci) Medial Meniscus Lateral Meciscus C- shaped
Peripheral 20-30% is vascular
Lateral Meciscus
Round shaped
Peripheral 10-25% vascular

5. Function of Menisci Deepen the articular surfaces of tibial plateau
Have role in:
Stability
Lubrication
Nutrition

6. Anterior Cruciate Ligament
Tibial attachment:
Between intercondylar eminence
Femoral attachment:
Posteromedial aspect of lateral femoral condyle
33mm long and 11mm wide
Consists of two bundles
Anteromedial: tight in flexion
Posterolateral: tight in extension

7. Posterior Cruciate Ligament
Tibial attachment:
Tbial sulcus below articular surface
Femoral attachement:
Anterolaterally on medial femoral condyle
38mm long and 13mm wide
2 bundles
Anterolateral: tight in flexion
Poseromedial: tight in extension

8. Medial Collateral Ligament
Two parts:
Superficial:
Originates from medial femoral condyle
Inserts at periosteum of proximal tibia deep to pes anserinus
Deep:
A capsular thickening and is blended with the medial meniscus

9. Lateral Collateral Ligament
Origin:
Lateral femoral epicondyle
Insertion:
At the fibular head

10. Statistics

11. Statistics

12. Mechanism of Injury

13. Mechanism of Injury

14. History

15. Examination Look, Feel, Move Special Test Anterior Drawer Test
Posterior Drawer Test
Valgus Stress Test
Varus Stress Test
McMurray Test

16. Special Tests
Anterior Drawer Test
Posterior Drawer Test

17. Special Tests
Varus Stress
Valgus Stress

18. Special Tests (Menisci)
McMurray

19. Special Tests (Menisci)
Apley’s Grinding

20. Investigations
X-rays
AP, Lateral
AP standing
Skyline

21. Investigations
X-rays
AP, Lateral
AP standing
Skyline

22. Investigations
X-rays
AP, Lateral
AP standing
Skyline

23. X-rays
Tibial eminence fracture
signifying ACL bony avulsion

24. MCL Injury
Avulsion
Stress Film

25. MRI- Meniscal Tear

26. MRI- ACL Tear

27. MRI- PCL Tear

28. MRI- Collateral Ligaments

29. Management of Acute Injury
Rest
Splint
Ice Packs
Analgesia
Quadriseps
Rom

30. Management of Acute Injury
Rest
Splint
Ice Packs
Analgesia
Quadriseps
Rom

31. Management of Acute Injury
Rest
Splint
Ice Packs
Analgesia
Quadriseps
Rom

32. Management of Acute Injury
Rest
Splint
Ice Packs
Analgesia
Quadriseps
Rom

33. Management of Acute Injury
Rest
Splint
Ice Packs
Analgesia
Quadriseps
Rom

34. Management of Specific Injuries

35. Meniscal Tears
Tears causing mechanical symptoms and those who fail conservative management requires operative treatment

36. Meniscal Tears

37. Meniscal Tears Partial Menisectomy Meniscal Repair Tears in white zone
Radial tears
Longitudinal tears
Bucket handle tears
Meniscal Repair
Peripheral, longitudinal tears in red zone

38. Meniscal Tears

39. Treatment for Meniscal Tears
Partial Menisectomy
Meniscal Repair

40. ACL Tears
Non-contact pivoting injuries associated with an audible pop and haemarthroses
Treatment is individualized depending on
Age
Level of activity
Instability
Associated injuries
Associated injuries:
Lateral Meniscal tears are more common than Medial Meniscal tears

41. ACL Tears Conservative Reconstruction
Isloated tears with no instability
Partial tears
Recreational activities
Light sport only
Sedentary
Quadriceps and Hamstring strengthening exercises
Associated injuries
Full thickness tears with instability
Competitive sports
Reconstruction with
Bone-Patella tendon
Hamstring Tendon

42. PCL Tears Direct blow to anterior tibia with knee flexed
Dashboard injury
Hyperextension or
Hyperflexion

43. PCL Tears Conservative Reconstruction Tendon Allograft
Grade I- PCL stretched (<5mm laxity)
Grade II- PCL Torn (5-9mm laxity)
Physiotherapy
Grade III- PCL torn (>10mm laxity)
Grade IV-A - PCL + LCL
Grade IV-B - PCL + MCL
Grade IV-C – PCL + ACL
Tendon Allograft

44. MCL Tears Valgus stress to the knee
Most commonly occurs at medial femoral attachment
Grade I- strain
Grade II- Partial Tear
Grade III- Complete Tear

45. MCL Tears Hinged Knee Brace for isolated injuries
Combined injuries will require reconstruction of the respective ligaments (ACL, PCL, posteromedial corner)

46. LCL tears
Isolated LCL injuries are uncommon and can be treated conservatively with brace if grade II
Complete tears with associated ACL/PCL requires reconstruction

48. Miscellaneous Injuries
Quadriceps and Patellar Tendon rupture
Patellar Tendinitis
Quadriceps Tendinitis

49. Quadriceps Tendon Rupture

50. Patellar Tendon Rupture

51. Quadriceps Tendinitis
Patellar Tendinitis
Quadriceps Tendinitis
Jumper’s Knee
Basketball and Volley ball
Pain and tenderness at inferior border of patella
Rest
NSAIDS
Physiotherapy
Pain at superior border of patella
Rest
NSAIDS
Physiotherapy

52. Patellar Tendinitis

53. Quadriceps Tendinitis

54. Pediatric knee Osgood Schlatter's Disease
Osteochondrosis or traction apophysitis of tibial tubercle
Most commonly seen in boys years
Increased in jumpers (basketball, volleyball) or sprinters and football
Pathophysiology
stress from extensor mechanism
Prognosis
self-limiting but does not resolve until growth has ended

55. Osgood Schlatter's Disease Presentation
Symptoms
pain on anterior aspect of knee
exacerbated by kneeling
Physical exam
enlarged tibial tubercle
tenderness over tibial tubercle
provocative test
pain on resisted knee extension

56. Osgood Schlatter's Disease Imaging
Radiographs
recommended views
lateral radiograph of the knee
findings
irregularity and fragmentation of the tibial tubercle
MRI
not essential for diagnosis

57. Osgood Schlatter's Disease Treatment
Nonoperative
NSAIDS, RICE (rest, ice, compression and elevation ) , activity modification, strapping/sleeves to decrease tension on the apophysitis and quadriceps stretching
indications
first line of treatment
outcomes
90% of patients have complete resolution
cast immobilization x 6 weeks
severe symptoms not responding to simple conservative management above
Operative
ossicle excision
indications 
refractory cases 

58. Summary Acute Injuries: splint, ice packs, NSAIDS & Physiotherapy
Specific Management:
Menisci: repair v/s menisectomy
ACL: depends upon the age and activity level
PCL: according to grades
MCL and LCL: depends upon isloated injuries or in combination